The Role of Neighborhood Poverty in the Association between Foreign-Born status and HIV Care Continuum Outcomes in Alameda County, California

Foreign-born persons living in the US have an increased risk of exposure to HIV and higher rates of HIV diagnosis (Patel-Larson et al. in Poster presented at the 2007 National HIV Prevention Conference, pp 2-5, 2007; Prosser et al. in JAMA 308:601-607, 2012). Foreign-born persons also tend to live in areas with high concentration of immigrants and more often neighborhoods of high poverty, for at least some time (Jargowsky in J Ethn Migr Stud 35:1129-1151, 2009). Using HIV surveillance data in Alameda County, California, we examined whether the association between immigrant status and the four outcomes on the HIV care cascade (late diagnosis, linkage to care within 30 days of diagnosis, retention in HIV care, and viral load status a year after diagnosis) differed by census tract poverty level. We used generalized estimating equations (GEE) adjusted for sex at birth, age, race, and transmission mode. Of 1235 individuals with HIV diagnosis reported between 2011 and 2016, 29% were foreign-born. Foreign-born status was significantly associated with late HIV diagnosis but not with linkage, retention in care, and achievement of undetectable viral load a year after diagnosis. Neighborhood poverty modified the association between immigrant status and retention in care, but not late diagnosis, linkage or viral load status. Our findings suggest that neighborhood resources may buffer against disparities in retention. Thus, immigrants in poorer neighborhoods may require more support to stay in care.